Presentaton by James A. Mercy, USA Safety 2016 World Conference, 18-21 September 2016, Tampere, Finland #Safety2016FIN

1. James A. Mercy, PhD
Division of Violence Prevention
National Center for Injury Prevention and Control
Centers for Disease Control and Prevention
THE CASE FOR A CROSS-CUTTING
APPROACH TO VIOLENCE PREVENTION

2. 2
CDC’s Srategic Vision for Violence Prevention

3. Violence Across the Lifespan
EARLY
CHILDHOOD ADOLESCENCE ADULTHOOD
Bullying Youth Violence
Child Maltreatment
Dating Violence
Sexual Violence
Intimate Partner Violence
Elder
Maltreatment
Suicide
Emotional or Psychological Violence and Witnessing

4. Perpetrators Often
Perpetrate and Victims
Often Suffer from
Multiple Forms of
Violence

5. Association of Dating Violence with
Other Youth Violence/Risk Behaviors
* All odds ratios are statistically significant
Risk Behavior % of Youth
Reporting
Risk Behavior
Odds of
Experiencing
Dating
Violence*
Odds of
Perpetrating
Dating
Violence*
Experience Bullying 49% 2x 2x
Perpetrate Bullying 42% 3x 3x
Experience Peer
Violence
8% 2x 3.5x
Perpetrate Peer
Violence
13% 3x 4x

6. 0
10
20
30
40
50
60
70
80
Peer Violence
Victimization
Dating Violence
Perpetration
Dating Violence
Victimization
%PerpetratingPeerViolence
Yes No
Percent Reporting Peer Violence Perpetration
by Other Forms of Violent Behaviors
Source: Swahn MH, Simon TR, Hertz MF et al. Linking dating violence, peer
violence, and suicidal behaviors. AJPM 2008;34(1):30-38

7. Exposure to Violence
Early in Life is
Associated with
Exposure Later in Life

8. Violence Against Children is Associated with Higher Levels of
Violence in Adulthood: Prevalence of Partner Violence by
History of Childhood Sexual Abuse
Source: Bott S, Guedes A , Goodwin M, Medoza JA. 2012. Violence against women in
Latin America and the Caribbean12 countries from LAC. Washington, DC: PAHO

9. Childhood
Exposures to
Violence
Perpetration sexual IPV
(N=450)
aOR*1 95% CI
None ref
One 1.2 0.4-3.4
Two 1.4 0.6-3.4
Three 3.7 1.5-9.5
Four or more 4.3 1.7-11.3
* p-value <0.05
1 Adjusted for close with father (1=yes)
Violent Experiences in Childhood and Men’s Perpetration of
Sexual Intimate Partner Violence (IPV) as a Young Adult,
Malawi 2014

10. Different Forms of
Violence Share Common
Risk and Protective
Factors

11. 11
CAN
IPV/TD
V
SV YV
Suicidal
Behavior
Elder
Abuse
Poor problem-solving skills X X X X X X
Poor behavioral control X X X X X X
History of violent
victimization
X X X X X X
Substance use X X X X X X
Witnessing violence X X X X X
Poor parent-child
relationships
X X X X X X
Family conflict X X X X X X
Examples of cross-cutting risk factors
Source: Wilkins, N., Tsao, B., Hertz, M., Davis, R., Klevens, J. (2014). Connecting the Dots: An
Overview of the Links Among Multiple Forms of Violence. Atlanta, GA: National Center for Injury
Prevention and Control, Centers for Disease Control and Prevention Oakland, CA: Prevention
Institute.

12. 12
Examples of cross-cutting risk factors
CAN IPV/TDV SV YV
Suicidal
Behavior
Elder
Abuse
Neighborhood poverty X X X X X
Community violence X X X X
Low neighborhood
support/cohesion
X X X X X
Harmful gender norms X X X X X
Weak health,
educational, economic,
and social policies/laws
X X X X X
Source: Wilkins, N., Tsao, B., Hertz, M., Davis, R., Klevens, J. (2014). Connecting the Dots: An
Overview of the Links Among Multiple Forms of Violence. Atlanta, GA: National Center for Injury
Prevention and Control, Centers for Disease Control and Prevention Oakland, CA: Prevention Institute.

13. 13
Different Forms of
Violence have Common
Consequences

14. HIV/AIDS
Chronic Lung
Disease
Fractures
Pregnancy
Complications
Cancer
Burns
Unintended
and Adolescent
Pregnancy
Fetal
Death
Internal
Injury
Diabetes
Heart
Disease
HIV
STDs
Violence
Alcohol
And Drugs
Unsafe
Sexual
Practices
Violence Is Costly and Destructive
Maternal and
Child Health
Injury Non-Communicable
Disease
Communicable Disease
and Risk Behaviors
Stroke
Alcohol
Smoking
Obesity
Physical
Inactivity
Multiple
Partners
Head
Injury
Mental Health
Problems
Suicide
Depression
and Anxiety
PTSD
Assault

15. Fraction of Adult Psychopathology Attributable to
Childhood Adversities, World Mental Health Surveys
in 21 Countries
22.9%
31.0%
41.6%
27.5%
29.8%
Mood Disorders
Anxiety Disorders
Behavioral Disorders
Substance Disorders
All Disorders
Source: Kessler et al. Childhood adversities and adult psychopathology in the
WHO World Mental Health Surveys. The British Journal of Psychiatry
2010;197:378-385.

16. 0
0,5
1
1,5
2
2,5
3
3,5
Adjustedoddsratio Exposure to Adversity in Childhood and
Adult Cardiovascular Disease
ACE = Adverse childhood experience
Source: Dong, M et al. Circulation 2004;110:1761–1766.
Number of ACEs
1 2 3 4 5,60 7,8

17. Multiple Adversity and Drinking, Ho Chi Minh
City, Viet Nam, 13-19 Year Olds, 2010
Multiple ACE
Drinking(%)
0
10
20
30
40
50
60
0 1 2 3 4+
Male
Female
Total
Source: Thai Thanh Truc, Kim Xuan Loan, Nguyen Do Nguyen, Jiandong Sun,
Jason Dixon and Michael Dunne; Queensland University of Technology &
Ho Chi Minh City University of Medicine and Pharmacy

18. Benefits of a Cross-Cutting
Approach to Violence
Prevention

19. Unify the Field in Order to Accelerate and
Maximize Efforts to Prevent Violence
IPV
EA
YV
SV CAN
Suicidal
Behavior
TDV

20. Areas of Intervention that have Potential
for Cross-Cutting Impact
Ø Approaches that address inequalities, social and
cultural norms and other community/societal level
risk factors
Ø Early childhood interventions
Ø Parent and family approaches
Ø Social and emotional learning approaches
Ø Bystander approaches
Ø Therapeutic interventions

21. • Opportunity:
Ø Create more efficient and sustainable
approaches to preventing violence
• Challenges:
Ø Siloed funding
Ø Limited evidence for impact of interventions and
policies on multiple types of violence
Ø The field is oriented to preventing violence one
type at a time
Cross-cutting Opportunities
and Challenges

22. Whatever affects one
directly, affects all
indirectly. I can never be
what I ought to be until
you are what you ought to
be. This is the interrelated
structure of reality.
Martin Luther King, Jr.

23. For more information
Visit CDC’s National Center for
Injury Prevention and Control web site:
www.cdc.gov/ncipc

24. The findings and conclusions of this presentation
have not been formally disseminated by the
Centers for Disease Control and Prevention
and should not be construed to represent
any agency determination or policy.
Disclaimer